Betamethasone Versus Ketorolac Injection for the Treatment of DeQuervains Tenosynovitis

OrthoCarolina Research Institute, Inc.64 enrolled

Overview

The purpose of this study is to determine if corticosteroid injection modifies the natural course of de Quervain tendinopathy compared to a toradol injection.

If steroids are effective for Dequervain tenosynovitis because of their anti-inflammatory properties, then there is a reasonable and rational argument to be made for the local injection of NSAIDS (non-steroidal anti-inflammatory drugs) into the first dorsal extensor compartment. Ketorolac is an NSAID that has been proven efficacious in the treatment of another musculoskeletal condition. Moreover, compared to betamethasone (or other injectable corticosteroids), injection of ketorolac decreases the patient exposure to the potential side-effects of corticosteroids, especially that of elevation of blood sugar levels in diabetics.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

DeQuervain Tendinopathy

Interventions

betamethasoneDRUG

1 cc of 1% lidocaine (without epinephrine) plus 1 cc of 6 mg/ml betamethasone

KetorolacDRUG

1 cc of 1% lidocaine (without epinephrine) plus 1 cc of 30 mg/ml of ketorolac

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of DeQuervain tendinopathy * Understands the local language and is willing and able to follow the requirements of the protocol * Understands the informed consent and signs the institutional review board/independent ethics committee (IRB/IEC) approved informed consent form Exclusion Criteria: * Patients who have an allergy to lidocaine, celestone, or ketorolac, nonsteroidal anti-inflammatory drugs (NSAIDs), or acetylsalicylic acid (ASA) * Patients who have an adverse reaction to lidocaine, celestone, or ketorolac (such as severe elevation of blood sugars in diabetics that caused medical complication) * Patients who have received a prior steroid injection within the past three months * Patients who have had a prior ipsilateral surgery for DeQuervain Tenosynovitis * Patients that have a skin lesion at the location of injection (such as trauma, eczema, rash) * Patients who have a current infection at the location of injection * Patients who have had iontophoresis within three months * Patients who are breast feeding, pregnant, or who plan to become pregnant in the next six months

Locations (1)

OrthoCarolina

Charlotte, North Carolina, United States

Outcomes

Primary Outcomes

Visual analog scale (VAS) of pain with finklestein test

Visual Analog Scale (VAS) of pain measured on 0 (no pain) - 10 (worst possible pain)

Time frame: 6 weeks post injection

Secondary Outcomes

Visual analog scale (VAS) of pain with tenderness over tendon

Visual Analog Scale (VAS) of pain measured on 0 (no pain) - 10 (worst possible pain)

Time frame: pre injection, 2 weeks post injection, 6 weeks post injection

Visual analog scale (VAS) of pain on radial side of wrist

Visual Analog Scale (VAS) of pain measured on 0 (no pain) - 10 (worst possible pain)

Time frame: pre injection, 2 weeks post injection, 6 weeks post injection, 3 months post injection, 6 month post injection

The Disabilities of the Arm, Shoulder, and Hand Score (DASH)

Patient-reported evaluation of symptoms as well as ability to perform certain activities. Score is 0-100 (higher scores indicate greater disability). Must answer at least 27/30 questions. Score is 1 to 5 per question. Score is then summed and divided by the number of completed questions. subtract 1 from this number then multiply by 25.

Time frame: pre injection, 2 weeks post injection, 6 weeks post injection, 3 months post injection, 6 months post injection

Veterans-Rand 12 (VR-12)

Quality of life using VR-12 subscores. Physical Health (PCS) subscore and Mental Health (MCS) subscore, not summed. Range reported in weighted units. Both PCS/MCS are score 0-100 with 100 indicating the highest level of health.

Time frame: pre injection, 2 weeks post injection, 6 weeks post injection, 3 months post injection, 6 months post injection

Pinch Strength

Data from ClinicalTrials.gov

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